*Names have been changed
Three years ago, Melody* stepped off a plane from Beijing in Vancouver and breezed through customs. “The official didn’t ask [if I was pregnant] so I didn’t tell,” she says through a translator. At 32 years-old, she was four months pregnant with her son David. Her husband waiting at home, Melody had entered B.C. on a visitors’ visa, intending to stay for months, for the sole purpose of having a baby on Canadian soil — thereby guaranteeing that baby citizenship. “Canada has a good environment, compared to the air pollution in China,” she says. “There is more choice for my child’s future learning and employment. And if my kid can get a Canadian passport there is an opportunity to come to Canada in the future.”
She headed to a birthing hotel in Richmond, where the owners — a couple in their 40s — showed her to her room, which had a single bed and crib. She had her own washroom, and says the room was “almost a luxury” — she had daily laundry service and meals brought to her door. In total, four or five families were living in the house at one time, but it wasn’t at capacity. She didn’t make friends there – most of the bedroom doors remained shut, the hallways were quiet. But the hotel provided all her meals, as well as nanny services for mothers who had brought their older children with them. “They could answer all the questions I had about giving birth, breastfeeding,” Melody says.
Birth tourism is legal, and despite common misconceptions, simply being a parent of a child born here is not enough to land a permanent resident visa for a prolonged length of time. Women here on visitor visas must go home with their children and apply to come back later, usually when their children are adults and can sponsor them. In the majority of cases, a Canadian passport is less a backdoor entrance into a Canada than an insurance policy for parents hoping to give their children better options.
But birthing hotels are unregulated and can go untracked. In some cities, the number of maternal hospital beds being taken up by non-residents is increasing, and, in some cases, they have become a flashpoint for people’s insecurity and xenophobia — especially urban areas such as Vancouver and Richmond, where a long history of racial tensions still simmers, and skyrocketing home prices (blamed in part on foreign investment) have some residents on edge. Here are the basics:
Why is birth tourism popular here?
Canada is one of the few developed countries, along with the United States, that grants birthright citizenship. When a baby is born here, he or she receives a birth certificate and can apply for a Canadian passport right away. With that comes the benefits of potentially living in Canada one day: access to our education system and public healthcare, for instance. It also can provide benefits in the parent’s home country: In China, for example, a child with a foreign passport can gain access to international schools, which are often more affordable than private schools, with a high standard of education.
If China has become the main source of birth tourism to the West Coast, it’s because of the country’s volatility, explains Will Tao, an immigration lawyer at Vancouver’s Larlee Rosenberg. “Everything is tied up with government. Many people have been able to ride the wealth of China, but they realize the foundation isn’t that strong. There is this idea that at any moment, things can turn for them, and what will happen to those things they worked towards?” Canada, then, becomes a stable “Plan B,” Tao says.
How common are they?
Maternity hotels dot Canada’s major cities and, in some areas, are growing in number: In July 2016, health ministry investigators in B.C. counted 26 in the province—a threefold increase since 2009. While no such data has been made public for Ontario, Sunnybrook hospital in Toronto also reported an increase in foreign births in 2015, receiving women from China, Nigeria, Saudi Arabia and the United Arab Emirates. In 2013, Montreal authorities said women from Haiti and French-speaking northern African countries “frequently” arrived to give birth in Canada.
Between March 2015 and March 2016, 295 of the 1,938 babies delivered at Richmond Hospital were to Chinese visitors. Public records released in July stated that the cost of non-resident births to the province of B.C. in 2014 and 2015 was $693,869. (Visitors to Canada do pay the hospital a fee for a baby to be born here. Melody, for example, paid around $10,000, which is a standard amount, for a standard birth procedure. “I think it is a really good deal,” she said). Some Richmond families have complained about being bumped to other facilities when they’ve shown up at the local hospital in labour and are told the facility is at capacity.
How are the hotels booked, and what are they like?
Finding a birthing or maternity hotel is similar to finding Airbnb accommodation. (The vast majority of birthing hotels in Vancouver are marketed to Chinese women on a Craigslist-style website called Vansky.com.) Private homeowners can provide rooms at a nightly rate, which range from swanky high-end options to basic rooms with a single bed (Melody paid just under $30 per night, a bill of $4,000 overall). Booked for months at a time, the rooms are most often home to women who travel here from abroad when they are around five months pregnant—while they’re still able to fly and, often, before they are obviously showing—to give birth in Canadian hospitals. The hotel owner provides meals, as well as a myriad of other services like translation, transportation and booking appointments with family doctors.
“I wasn’t scared at the time,” Melody says. “But now I’ve realized that it was a scary experience without your parents or family around. Because it was my first child, I didn’t have much knowledge.”
What are the tensions around them?
In some cases, maternity hotels have raised the ire of their neighbours and concern from the health services community. This happened in Richmond, B.C. — a suburb where, according to the 2011 census, 49 percent of the population are Chinese Canadians.
In 2015, long-time Richmond resident Kerry Starchuk discovered the large pink stucco house next door to hers was housing pregnant women from China. From her house, she watched food being delivered and vehicles picking up and dropping off pregnant women. In her mind, it marked one more way her community was changing. (In 2014, noting there were signs in her community written only in Chinese, she lobbied the city’s council to make it mandatory that have all signs include English or French).
She started a petition (e-397), calling on the federal government to eliminate birthright citizenship, and Conservative Richmond Centre MP Alice Wong co-signed the document, which argues that, “the practice of birth tourism can be very costly to taxpayers,” and “take[s] advantage of Canada’s public health system and social security programs.”
Between July and October of that year, Starchuk’s petition gathered 8,568 signatures from across Canada, enough for Wong to take it to the House of Commons (the benchmark for this is 500 signatures). “Richmond Hospital, in the last fiscal year, reported nearly one-in-six births were to non-residents,” Wong wrote in a statement. “This has led to capacity issues.” The petition was presented in Parliament in October for review, and tabled in December with a response from Minister of Immigration, Refugees and Citizenship John McCallum. “While there may be instances of expectant mothers who are foreign nationals who travel to Canada to give birth,” McCallum wrote, abolishing birthright citizenship “would represent a significant change to how Canadian citizenship is acquired.”
What’s the experience like for the women who come to give birth?
There’s a great amount of anxiety that comes with travelling to another country to give birth, says Daisy Zhu, a PhD candidate at the University of Toronto’s Ontario Institute for Studies in Education, who researches immigrant mothers in Canada. The vast majority do not speak the language, and are often ostracized. “Many Canadians don’t want to talk to these mothers; they just use their imaginations to think of all the Chinese people coming here to take citizenship,” she says.
Zhu has experienced the workings of a maternity hotel first hand — a facility in Scarborough, Ont., that she used when her son was born two years ago, even though she was already a permanent resident. Zhu is from Wenzhou in the province of Zhejiang, and moved to Canada as a postgraduate student in 2006. The maternity hotel gave her something that was missing from her hospital birth experience—a cultural connection. In China, new mothers adhere to a strict meal plan tradition for 30 days after giving birth. Each meal is made with precise ingredients and follows a complex system; some meals are cooked with salt, some without, for instance. Typically, the mothers of new moms prepare and serve these meals to their daughters. Zhu’s parents were not in Toronto when she gave birth. So she paid $100 per day for room and board at a birthing hotel, where daily packets of food were delivered outside her bedroom door.
“In Canada, the immigration policy is to emphasize multiculturalism,” says Zhu, “but many people don’t really [think of it as something to] practice.” She notes the similarities between Starchuk’s petition against Chinese signage in Richmond, and protests against birth tourism in Hong Kong. In 2012, hospital executives there reported a doubling of women from mainland China arriving at hospitals through emergency rooms to give birth. The benefits are similar—better medical treatment and public education.
There are also parallels between Richmond and the wealthy Los Angeles suburb of Chino Hills. In 2012, Chino Hills residents protested, and shut down, a maternity hotel for Chinese women in the hills above their homes. An activist there referred to birth tourism as, “invasion by birth canal.”
Rima Wilkes, a sociology professor at the University of British Columbia, says racism could be a factor in some of the protests against the hotels here as well. “Chinese people have been here for a long time, but we had a whole series of discriminatory laws to keep out racialized minorities,” Wilkes says. “That fostered the idea that real, ‘authentic’ Canadian is a white person and that the Chinese are new.” This, she says, lead to the idea of what makes a “good immigrant” – someone who comes here for the right reasons, under the right circumstances.
How are hospitals and doctors responding?
The increase in birth tourism has led to changes in hospital policy in Canada, and has doctors facing some delicate ethical issues.
Sunnybrook Hospital in Toronto now abstains from providing high-risk treatment and ultrasounds for foreign women with no OHIP coverage, and Tao has fielded anonymous emails from Richmond hospital staff looking for legal advice, saying they can’t keep up with the number of births.
“As a clinician, I provide obstetrical care and this is an issue I have come into,” says Dr. Murray*, a Toronto-based family doctor, who asked to remain anonymous. “Until 24 months ago, it was something I came across every once in a while, and now [Sunnybrook] has a policy on it because so many [women from abroad are] showing up.”
“I’ve had women show up on my doorstep or be referred through other patients. It’s very common for a patient to say her sister or friend is pregnant and needs care, but then she arrives and is actually from another country and has insurance or is planning to pay cash.” Dr. Murray explains, “Then I’m in a difficult ethical position. I can’t register those women at the hospital as a patient of mine because the hospital won’t accept non-OHIP [Ontario Health Insurance Plan] cases, so I have to tell them, ‘You didn’t hear this from me, but if you show up to the emergency room in labour they have an obligation to take care of you.’”
Some doctors are hesitant to deliver a baby to a foreign national because if something goes wrong he or she could be sued for malpractice in another country. The Canadian Medical Protective Association (CMPA), which provides physicians with assistance in medical legal cases, says they can’t support foreign cases against Canadian doctors. “You can’t turn someone away because of concern about payment,” explains Dr. Doug Bell, associative executive director at CMPA. “But if there is nothing urgent, you are under no obligation to provide care.”
Should the government be stepping in?
Andrew Griffith, a former director general of federal Citizenship and Immigration and writer on multiculturalism, insists that the numbers aren’t large enough to take any drastic action in Canada. He does, however, believe that federal and provincial governments should take on annual reporting of births to non-resident women. “And you should be able to crack down on the consulting companies and birthing hotels, in terms of legislative action,” he adds.
Tao agrees. From his perspective, this is an issue that the federal government needs to take on: “Our government has no oversight. The clients who come from overseas often have absolutely no idea what the law is,” he says, adding that they may have been given incorrect information by people overseas. In this sense, a government crackdown would be aimed at protecting women coming to Canada to give birth, as much as anything else.
Melody’s story didn’t end when she returned to China. When she became pregnant again in early 2016, she booked a flight back to Vancouver, this time with her husband and first child in tow. “I felt the hospital was very professional, and I wanted everything to be fair between my children,” she says.
This time, she felt more confident. She and her husband used an immigration and travel agency based in Beijing to help them rent a house. After she gave birth to her second son, Tayson, she returned to the birthing hotel for postnatal care before heading back home. The family doesn’t have any immediate plans to return to Canada. But she’s glad that, for her children, it will always be an option.